Underlying Causes of TIA and Minor Ischemic Stroke and Risk of Major Vascular Events-Reference-Cited by-同舟云学术

Underlying Causes of TIA and Minor Ischemic Stroke and Risk of Major Vascular Events

Published:2023-11-01 Issue:11 Volume:80 Page:1199
ISSN:2168-6149
Container-title:JAMA Neurology
language:en
Short-container-title:JAMA Neurol

Author:

Lavallée Philippa C.¹,Charles Hugo¹,Albers Gregory W.²,Caplan Louis R.³,Donnan Geoffrey A.⁴,Ferro José M.⁵,Hennerici Michael G.⁶,Labreuche Julien¹⁷,Molina Carlos⁸,Rothwell Peter M.⁹,Steg Philippe Gabriel¹⁰,Touboul Pierre-Jean¹,Uchiyama Shinichiro¹¹,Vicaut Éric¹²,Wong Lawrence K. S.¹³,Amarenco Pierre¹¹⁴,Ameriso Sebastian¹⁵,Nora Gandolfo Claudia¹⁵,Povedano Guillermo¹⁵,Sagesse Javier¹⁵,Pavon Heman¹⁵,Cancino Jorge¹⁵,Toledo Walter¹⁵,Huang Yinin¹⁵,Gong Xiping¹⁵,Martin Yeato¹⁵,Mi Donghu¹⁵,Song Tian¹⁵,Wang Yilong¹⁵,Wang Yongjun¹⁵,Chandgfend Fran¹⁵,Contago Guo¹⁵,Hongyun Jiao¹⁵,Intao Heman¹⁵,Jixing Wu¹⁵,Liquing Song¹⁵,Liwen Tai¹⁵,Ran Liu¹⁵,Shujuan Tian¹⁵,Wenhong Liu¹⁵,Hong Soi Tak¹⁵,Wong Lawrence¹⁵,Roxanna Liu¹⁵,Flasar Roman¹⁵,Ziktova Bedriska¹⁵,Reif Michael¹⁵,Goldemund Daniel Sanak¹⁵,Neumann Jiri¹⁵,Svakov Dagmar¹⁵,Sanak Daniel¹⁵,Kral Michael¹⁵,Skoloudik David¹⁵,Vaclavik Daniel¹⁵,Kuhila Martin¹⁵,Amarenco Pierre¹⁵,Cabrejo Lucie¹⁵,Guidoux Céline¹⁵,Hobeanu Cristina Maria¹⁵,Lavallée Philippa¹⁵,Meseguer Elena¹⁵,Audebert Henrich¹⁵,Menger Daniel¹⁵,Heide Wofgang¹⁵,Lipp Saskia¹⁵,Ozalp Huriye¹⁵,Sctzmann Christine¹⁵,Weimar Christian¹⁵,Platzbecker Katharina¹⁵,Ringleb Peter¹⁵,Hennerici Michel G¹⁵,Griebe Martin¹⁵,Knoll Olaf Katrin¹⁵,Willmann Olaf¹⁵,Harmut Faiss Juergen¹⁵,Dilan Susan¹⁵,Kobersteein Anja¹⁵,Krimmer Katarina¹⁵,Tietz Sandra¹⁵,Wienecke Peter¹⁵,Hamann Gerhard¹⁵,Burkhardt Nico¹⁵,Liebetrau Martin¹⁵,Mueller Nadine¹⁵,Wagner Michaela¹⁵,Strivastava Dr¹⁵,Kelly Peter¹⁵,Tanne Hashomer David¹⁵,Cavazzuti Milena¹⁵,Anticoli Sabrina¹⁵,Toni Danilo¹⁵,Nagata Ken¹⁵,Okada Yasushi¹⁵,Yamagami Hiroshi¹⁵,Minematsu Kazuo¹⁵,Nakagawara Jojo¹⁵,Uchiyama Shinchiro¹⁵,Chui Lee Byung¹⁵,Woo Yoon Byung¹⁵,Hoe Ji¹⁵,Moo Park Jong¹⁵,Abboud Halim¹⁵,Koussa Salam¹⁵,Awada Adnan¹⁵,Sin Tan Kay¹⁵,Arauz Antonio¹⁵,Gongora Frnando¹⁵,Valenzuela Adrian Infante¹⁵,Esamilla Juan M.¹⁵,Canhao Patricia¹⁵,Ferro ******-¹⁵,Fonseca Ana Catarina¹⁵,Correia Manuel¹⁵,Tuna Assuncao¹⁵,Sternic Nada¹⁵,Mijajlovic Milija¹⁵,Dupejova Beata¹⁵,Szedelyova Jana¹⁵,Smirkova Renata¹⁵,Segura Tomas¹⁵,Molina Carlos¹⁵,Rodriguez Ana¹⁵,Silva Yolanda¹⁵,Tejada Javier¹⁵,Purroy Francisco¹⁵,Masjuan Jaime¹⁵,Vivancos Jose¹⁵,Palomeras Ernest¹⁵,Gamemro Miguel Angel¹⁵,Arenillas JF¹⁵,Calleja Anna¹⁵,Rojo Esther¹⁵,Buchan Alastair¹⁵,Rothwell Peter¹⁵,Hai Lee Tsong¹⁵,Chang Ku Chou¹⁵,Huang Yu-Ching¹⁵,Lin Ruey-Tay¹⁵,Timkao Somsak¹⁵,

Affiliation:

1. Department of Neurology and Stroke Center, Bichat Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM) Laboratory for Vascular Translational Science (LVTS)–U1148, University Paris-Cité, Paris, France

2. Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, California

3. Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts

4. Melbourne Brain Centre, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia

5. Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisbon, Portugal

6. Department of Neurology, Universitäts Medizin Mannheim, University of Heidelberg, Heidelberg, Germany

7. Department of Biostatistics, Centre Hospitalier Universitaire Lille, Lille, France

8. Stroke Unit, Department of Neurology, Vall d’Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain

9. Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom

10. Department of Cardiology, Hôpital Bichat, Université Paris Cité, AP-HP, INSERM LVTS-U1148, Institut Universitaire de France, Paris, France

11. Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan

12. Department of Biostatistics, Fernand Widal Hospital, AP-HP, Université Paris-Cité, Paris, France

13. Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong

14. Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada

15. for the TIAregistry.org Investigators

Abstract

ImportanceThe coexistence of underlying causes in patients with transient ischemic attack (TIA) or minor ischemic stroke as well as their associated 5-year risks are not well known.ObjectiveTo apply the ASCOD (atherosclerosis, small vessel disease, cardiac pathology, other cause, or dissection) grading system to assess coexistence of underlying causes of TIA and minor ischemic stroke and the 5-year risk for major vascular events.Design, Setting, and ParticipantsThis international registry cohort (TIAregistry.org) study enrolled 4789 patients from June 1, 2009, to December 31, 2011, with 1- to 5-year follow-up at 61 sites in 21 countries. Eligible patients had a TIA or minor stroke (with modified Rankin Scale score of 0 or 1) within the last 7 days. Among these, 3847 patients completed the 5-year follow-up by December 31, 2016. Data were analyzed from October 1, 2022, to June 15, 2023.ExposureFive-year follow-up.Main Outcomes and MeasuresEstimated 5-year risk of the composite outcome of stroke, acute coronary syndrome, or cardiovascular death.ResultsA total of 3847 patients (mean [SD] age, 66.4 [13.2] years; 2295 men [59.7%]) in 42 sites were enrolled and participated in the 5-year follow-up cohort (median percentage of 5-year follow-up per center was 92.3% [IQR, 83.4%-97.8%]). In 998 patients with probable or possible causal atherosclerotic disease, 489 (49.0%) had some form of small vessel disease (SVD), including 110 (11.0%) in whom a lacunar stroke was also probably or possibly causal, and 504 (50.5%) had no SVD; 275 (27.6%) had some cardiac findings, including 225 (22.6%) in whom cardiac pathology was also probably or possibly causal, and 702 (70.3%) had no cardiac findings. Compared with patients with none of the 5 ASCOD categories of disease (n = 484), the 5-year rate of major vascular events was almost 5 times higher (hazard ratio [HR], 4.86 [95% CI, 3.07-7.72]; P &lt; .001) in patients with causal atherosclerosis, 2.5 times higher (HR, 2.57 [95% CI, 1.58-4.20]; P &lt; .001) in patients with causal lacunar stroke or lacunar syndrome, and 4 times higher (HR, 4.01 [95% CI, 2.50-6.44]; P &lt; .001) in patients with causal cardiac pathology.Conclusion and RelevanceThe findings of this cohort study suggest that in patients with TIA and minor ischemic stroke, the coexistence of atherosclerosis, SVD, cardiac pathology, dissection, or other causes is substantial, and the 5-year risk of a major vascular event varies considerably across the 5 categories of underlying diseases. These findings further suggest the need for secondary prevention strategies based on pathophysiology rather than a one-size-fits-all approach.

Publisher

American Medical Association (AMA)

Subject

Neurology (clinical)

Link

https://jamanetwork.com/journals/jamaneurology/articlepdf/2809775/jamaneurology_lavalle_2023_oi_230067_1699556032.56573.pdf

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